Low carbohydrate diets one option for managing type 2 diabetes, but one size does not fit all, says BDA

13 November 2018

The British Dietetic Association (BDA) has today published a policy statement clarifying its long-held position that a low carbohydrate diet should be one of a number of possible dietary approaches suitable for managing type 2 diabetes in adults*. Weight loss remains the cornerstone of effective type 2 diabetes management for people who are overweight, regardless of how it is achieved, be that on a low-carbohydrate, low-fat or very-low-calorie diet.

The statement also makes clear that more research is needed to ascertain the long-term health impacts of a low-carbohydrate diet, including on heart health. Research looking at low carbohydrate diets for longer than 12 months is currently lacking.

A low-carbohydrate approach, defined as diets containing between 50 and 130g of carbohydrate a day, have been one of a number of dietary approaches used by dietitians with patients with type 2 diabetes for a number of years. While some patients have found success with this approach, it will not be suitable for all patients, especially as many find it difficult to adhere to low-carbohydrate diets. A poorly planned low-carbohydrate diet, like any poorly planned diet, can tend to be low in key nutrients, including fibre or essential vitamins, which is why it is important for patients to receive support from a dietitian.

Dietitians have an important role in ensuring that people are able to eat a healthy, well rounded diet that suits them and their lifestyle, and which they are able to maintain in the long term. Dietitians’ dietary recommendations are individualised, taking account of a range of elements including taste preferences, cultural factors, medications, exercise levels and cooking skills.

Duane Mellor is a diabetes specialist and one of the authors of the policy statement. “Low-carbohydrate diets have been an option for patients with type 2 diabetes for many years, and were included in Diabetes UK’s nutritional guidelines of type 2 diabetes in 2011 and again in 2018. For some people, these diets will be a way to successfully lose weight and improve their glycaemic control.”

“However, it’s important to be clear that low-carbohydrate diets are not a sliver bullet. Not everyone finds it a suitable approach for them, and we know that other approaches have also been very effective in controlling and even reversing type 2 diabetes. Some advocates have claimed everyone should eat a low-carbohydrate diet, but this fails to take into account the many different factors that influence a person’s preference for their way of eating including culture, income and what works best for them. This is further complicated by the fact that low carbohydrate diets are often poorly defined, and the amounts of carbohydrate included varies significantly.”

Public Health England and the government’s Scientific Advisory Committee on Nutrition (SACN) are currently reviewing the evidence in relation to low carbohydrate diets and type 2 diabetes, and are expected to publish their findings in late 2019.

*The BDA’s new policy statement doesn’t apply to children, or people with type 1 diabetes or gestational diabetes.

The British Dietetic Association (BDA), founded in 1936, is the professional association and trade union for dietitians in Great Britain and Northern Ireland. It is the nation’s largest organisation of food and nutrition professionals with over 9,000 members.

Dietitians are highly qualified health professionals that assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. They are statutorily regulated by the Health and Care Professions Council (HCPC), alongside other Allied Health Professions.

Dietitians use the most up to date public health and scientific research on food, health and disease, which they translate into practical guidance to enable people to make appropriate lifestyle and food choices. They work in the NHS, private practice, industry, education, research, sport, media and government. Their advice influences food and health policy across the spectrum from government and global industry to local communities and individuals.

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